Flare: Biochemical versus Clinical Flare (Biochemical being PCa flare caused by starting ADT using LHRH drugs, in some patients with higher levels of psa's and higher Gleason scores, have more risks)-my added words here(all in blue). This possible scenario is for real and if a higher risk patient especially, why your uro-doc had better know his drugs and how they work). My uro-doc although very busy and considered very knowledgable (flunked this test on me...luckily I did not notice any significant damage, could have had PCa growth thanks to this ____.)

Before beginning a course of treatment with any LHRH agonist (Lupron', Zoladex , Trelstar LA , Viadur'or Eligard is important to initiate measures to prevent "flare." Flare results from an initial surge in testosterone production upon the initiation of the LHRH agonist (LHRH-A) caused by the release LH. The LHRH-A will eventually down-regulate LH, but may take up to 14 days. During this time, cell growth that mediated by testosterone is increased. This means that prostate cells, benign or malignant, are being stimulated to grow for as much as the first two weeks of LHRH-A therapy if no measure to prevent flare or counter its effects has been initiated.

In most men currently initiating Lupron, Zoladex, Trelstar LA, Viadur or other LHRH agonist therapy, the effects of flare are only detected by measuring the testosterone and PSA levels and observing the testosterone surge followed by a rise in PSA. This is because cause most patients diagnosed with PC today have a small tumor volume and the effects of increased cancer growth go un-noiticed.

. The effect of testosterone surge in this category of PC

patients is called biochemical flare (Fig. 55) since it is unassociated with clinical manifestations of worsening PC. On careful questioning of men with biochemical flare, however, you will often hear them remark that they noticed an increased desire for sexual activity, which is an expression of testosterone surge.

In the presence of significant amounts of tumor, however, flare result in the aggravation of clinical symptoms, i.e. clinical

1 (Fig. 56). Such flare may involve growth of PC or normal prostate tissue within the prostate gland which may reduce the caliber of the urinary stream and possibly lead to complete obstruction of flow (urinary retention). Clinical flare can result in an increase in bone pain if bone metastases are present. In more serious circumstances, flare can result in spinal cord compression with possible paralysis if PC tissue near the spinal cord is stimulated to grow. Flare may result in kidney failure if lymph-nodes near the the ureters—the drainage tubes from the kidneys—increase in size due to increased tumor growth and compress the ureters. (See Physician's Note 18.) Such occures are examples of clinical flare.

(zufus-my uro-doc whom I fired (2yrs)later did not give me casodex 12-14 days as is recommended, prior to zoladex shot, thus I had the very real potential for flare or flare issues....he should have known better...I had higher stats...realize that if you are at risk because of your stats (range) that casodex and similar should be given to the patient first) Dx-bpsa 46.6 12/12 biopsies 75-95% in each, Gleasons 7,8,9's (that is in the higher risk group)

If you are going to use the LHRH drug ask your uro-doc or onco-doc(etc.) if flare is possible. If you have somewhat higher stats don't ask demand or tell them I want to be put on casodex or equals for 12-14 days prior to the LHRH shot, or you have those risks above, can you imagine some of those???

Knowledge is your friend in PCa, it is amazing what things are not done by some supposedly qualified docs, verified such it is even mentioned by Dr. Strum in article "What every doctor and patient should know about PCa" (circa around 2005 published)

New drug Degarelix is likely a good choice, it is said not to have the flare properties...suggest one study up on that new drug.